Synopsis: Medicaid and children's health insurance program. Defines
"emergency" for purposes of the children's health insurance program
(CHIP). Prohibits cost sharing under CHIP for emergency services
provided within a hospital emergency department. Requires the office
of Medicaid policy and planning and the office administering CHIP to
request repayment of an overpayment made to a provider under the
Medicaid program or CHIP.

Effective: July 1, 2000.

Miller, Simpson

January 10, 2000, read first time and referred to Committee on Health and Provider
Services.
January 20, 2000, amended, reported favorably _ Do Pass.

January 21, 2000

Second Regular Session 111th General Assembly (2000)

PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in thisstyletype.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or thisstyletype reconciles conflicts
between statutes enacted by the 1999 General Assembly.

SENATE BILL No. 504

A BILL FOR AN ACT to amend the Indiana Code concerning
human services.

Be it enacted by the General Assembly of the State of Indiana:

SECTION 1. IC 12-7-2-76.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 76.5. (a) "Emergency",
for purposes of IC 12-20, means an unpredictable circumstance or a
series of unpredictable circumstances that:
(1) place the health or safety of a household or a member of a
household in jeopardy; and
(2) cannot be remedied in a timely manner by means other than
township assistance. (b) "Emergency", for purposes of IC 12-17.6, has the meaning
set forth in IC 12-17.6-1-2.6.
SECTION 2. IC 12-15-23-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 2. If the administrator
determines that a provider has received payments the provider is not
entitled to, the administrator may: (1) request in writing that the provider repay the amount of
the overpayment; and
(2) enter into an agreement with the provider stating that the

amount of the overpayment shall be deducted from subsequent
payments to the provider.
SECTION 3. IC 12-17.6-1-2.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2000]: Sec. 2.6. "Emergency" means a
medical condition that arises suddenly and unexpectedly and
manifests itself by acute symptoms of such severity, including
severe pain, that the absence of immediate medical attention could
reasonably be expected by a prudent lay person who possesses an
average knowledge of health and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily
functions; or
(3) result in serious dysfunction of a bodily organ or part of
the individual.
SECTION 4. IC 12-17.6-2-13 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2000]: Sec. 13. If the office determines that
an overpayment has been made to a provider, the office shall
request in writing that the provider repay the amount of the
overpayment.
SECTION 5. IC 12-17.6-4-3, AS ADDED BY P.L.273-1999,
SECTION 177, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2000]: Sec. 3. Premium and cost sharing
amounts established by the office are limited by the following:
(1) Deductibles, coinsurance, or other cost sharing is not
permitted with respect to benefits for: (A) well-baby and well-child care, including age appropriate
immunizations; and
(B) services provided for treatment of an emergency in an
emergency department of a hospital licensed under
IC 16-21.
(2) Premiums and other cost sharing may be imposed based on
family income. However, the total annual aggregate cost sharing
with respect to all children in a family under this article may not
exceed five percent (5%) of the family's income for the year.